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EPITOME 

ON 

BLOOD PRESSURE 

- - $> - 

Aids to the interpretation of Blood Pressures 

for 

The Qeneral Practitioner 

WITH KEY TO DIAQNOSIS 
BY 

BURTON BAKER QROVER, M. D. 

I € 

Author of “Handbook of Electrotherapy” and “High Frequency Practice 
President of the Western Electrotherapeutic Association 1919- 
1921; President of the Western School of Physiotherapy; 

Fellow of the American Electrotherapeutic Associa¬ 
tion; Vice-presiuant of the American College 
of Ra^'ology and Physiotherapy; 

Fellow of the American Med¬ 
ical Association, Etc. 





'RC'M- 

GtT 


Copyright 1924 

BY 

Burton Baker Grover, M. D. 


PREFACE 


F is the custom of many, writing upon 
the subject of blood pressure, to refer to 
the insipid analogy of the mechano- 
hydraulic simile for the left side or inner 
circuit of the heart; the pump (heart), the outlet 
valve (semilunar valve), the compression chamber 
(aorta), the mains (arterioles ending in capillaries), 
the return drains (venous vessels with valves), the 
reservoir (auricle), and the inlet valve (Auriculo- 
ventricular valve). This picture is useful only for 
one purpose,—to convey a quick impression of the 
cardio-vascular system as an independent entity. 

But the cardiovascular system does not exist in 
the body for the purpose of satisfying itself alone. 
It is a system subservient to the many needs of 
the multiple tissues that require the materials car¬ 
ried by the blood. At all times it acts in the in¬ 
terest of and is influenced by the behavior of these 
tissues. So that the earliest derangement of the 
cardiovascular system really begins in the tissues. 

Owing to the unusual flexibility of the cardio¬ 
vascular unit, the transient tissue disturbances in- 



['53 












duce but fleeting deviations in the action of the 
heart and vessels. If the tissue damage is more 
permanent, then the heart and vascular derange¬ 
ments become compensatingly permanent. I think 
this concept is important, for it stresses the impera¬ 
tive necessity to be ever vigilant in detecting the 
earliest possible alterations in the cardio-vascular 
fitness of the individual. 

Here, then, Doctor Grover has done us a great 
service. I take it that what Doctor Grover so 
aptly calls “hyperpiesia” is exactly the warning syn¬ 
drome that makes it possible to appreciate an 
early premonition suggesting impending transition 
to subsequent permanent damage, and to which 
there has been given the name “hypertension.” 
From the viewpoint of therapeutic possibility, 
hyperpiesia is signally more important than hyper¬ 
tension, for reasons that are necessarily obvious. 

With these basic considerations constantly in 
mind, it is refreshing, enlightening and progres¬ 
sively scientific to have these lucid and' lucent 
epitomized aphorisms, each one obviously repre¬ 
senting the completed crystal that separates only 
from a properly concentrated and long standing 
experience. 


[ 6 ] 




There is nothing to subtract from the essay, and 
it is certain that Doctor Grover’s epitome cannot 
fail to interest all workers in cardiology; but its 
truer usefulness lies in carrying important mes¬ 
sages to the general practitioner who, being desti¬ 
tute of facilities for acquiring expert guidance in 
cardiologic inquiry, must rest content to have clear, 
concise and collected information that is immedi¬ 
ately pertinent to clinical requirements. 

A. J. PACINI, M. D., 

Chicago, 1924. Biophysicist. 


171 







INTRODUCTION 


YPERTENSION which at the present 
time is so prevalent and extensively rec¬ 
ognized is a condition intensified by 
hyper-cultivation. While modern diag¬ 
nostic methods are more exact and many more 
cases than heretofore are recognized, it is a fact 
that hypertension is on the increase. 

By many physicians hypertension is thought to 
be a condition wisely provided by nature as a com¬ 
pensatory measure. Cardiac hypertrophy does not 
per se cause increased blood pressure, neither does 
impeding the circulation through the kidneys cause 
hypertension. 

Increased blood pressure is a premonitory indi¬ 
cation of pathological changes yet to come, and is 
not, as has been supposed, the result of arterial 
changes. 

While it is the desire of the writer not to ex¬ 
aggerate the danger of this condition, he feels it 
to be sufficiently dangerous to give rise to alarm. 

Over two million persons within the United 



[ 9 ] 

















States are known to be suffering from organic heart 
disease, seventy-five per cent of which is preceded 
by hyperpiesia. Adding to this number the cases 
not classified with heart disease, together with a 
greater number of unknown cases makes a total 
that is almost appalling. A conservative estimate 
of the number of cases of hyperpiesia and hyper¬ 
tension in the United States would place the num¬ 
ber at several millions. The number of deaths in 
which hyperpiesia is concerned as an etiological 
factor far exceeds those from any other disease. 
The importance of the causes of hypertension as 
morbific agents is of the same order as that of car. 
cer and tuberculosis combined. 


Deaths in 1922 


Tuberculosis 

Apoplexy _ 

Nephritis _ 

Heart disease 
Cancer _ 


114,000 

80,000 

90,000 

150,000 

83,000 


[ 10 ] 








No longer can there be any excuse for confusion 
between arteriosclerosis and hypertension. Arter¬ 
iosclerosis may be the end result of a long contin¬ 
ued hyperpiesia, but is never the cause of hyper¬ 
tension. As a general proposition increased ar¬ 
terial tension precedes kidney dysfunction. How 
ever, hypertension may be a sequel of acute ne¬ 
phritis. 


In uremia of pregnancy the increased arterial 
tension may or may not be responsible for the con¬ 
dition. 


Superficial arteries may be atheromatous while 
the deep central arteries may be in a normal state. 
Atheromatous radials may exist without a pre¬ 
vious hyperpiesia. General arteriosclerosis may 
exist with normal pressures, but if it could be 
known, it is quite probable that hyperpiesia was an 
important factor in its development. 


[Ill 








ARTERIAL TENSION 


f | THE terms “high blood pressure,” “hyperten- 
sion,” “hyperpiesia,” “essential hypertension,” 
“hyperintensive cardiovascular disease” are to 
depict a condition of vascular tension. These terms 
should not be used indiscriminately. For the pur¬ 
pose of clearing the analogy of these terms the fol¬ 
lowing definitions are assigned: 

HIGH BLOOD PRESSURE may mean any 
condition characterized by increased vascular ten¬ 
sion. 

HYPERTENSION is a condition of the vascu¬ 
lar system characterized by a persistent and con¬ 
tinuous elevation of the systolic and diastolic blood 
pressures, and the use of the term should be lim¬ 
ited to cases with discoverable vascular lesions. 
These lesions are usually of the sclerotic type and 
occur in the heart, kidneys or brain, but may occur 
in any part of the vascular system. 

HYPERPIESIA or HYPERPIESIS is a condi¬ 
tion characterized by a persistent elevation of blood 
pressure without discoverable cardiovascular 
changes. 


[133 




ESSENTIAL HYPERTENSION. The use of 
the term “essential hypertension” is unfortunate. 
Webster defines the word essential as necessary to 
the existence of a thing. To man’s existence hyper¬ 
tension is no more essential than headache. 

Hyperpiesia is a symptom of impaired physiol¬ 
ogy. Hypertension means pathologic physiology. 


Increased vascular tension is the cause, not the 
effect of pathological changes. 


Hyperpiesia is the most constant causative fac¬ 
tor in myocarditis. 


Hyperpiesis is not per se produced by heart 
force, but rather by the condition prevailing in the 
blood vessels, chiefly in the arterioles and capil¬ 
laries. Loss of elasticity of the arterial walls calls 
for increased heart force to overcome the resist¬ 
ance. 

HYPOTENSION is a condition of the vascular 
system characterized by a persistent decreased vas¬ 
cular tension and is usually accompanied with a 
definite pathology. 


[ 14 ] 








This book is interleaved for the convenience of the physi¬ 
cian in making notes on his cases and commenting on the 
statements made by the author. 

Constructive Criticism Invited 


NOTES 




NOTES 




Hypotension is the rule in psoriasis, lichen 
planus, erythematous lupus, acute infections and 
tuberculosis. 

Causative factors in hypotension in order of fre¬ 
quency are : diseases of the digestive tract, diseases 
of the vascular system; infections and psycho¬ 
neuroses. 

Complaints of patients with hypotension in order 
of frequency are: exhaustion, nervousness, head¬ 
ache, indigestion, constipation, numbness of the 
extremities and vague abdominal pains. 

An occasional high systolic pressure has no par¬ 
ticular significance; only a persistent pressure 
above normal constitutes hyperpiesia. 

Hyperpiesia is the advance agent advising us of 
approaching cardiovascular lesions. 

Hyperpiesia is an etiological factor in nearly all 
cardiovascular pathology. 

A long period of time is essential for hyperpiesia 
to induce cardiovascular changes. 

There is no condition so insidious as hyperpiesia. 


[ 15 ] 









Hyperpiesia is now considered to be the primary 
cause of structural changes in the arteries. 

Whenever hyperpiesia exists, it may be known 
that in the course of time cardiac hypertrophy will 
follow unless the condition is removed. 


The argument that an increased arterial tension 
is compensatory and should not be combated will 
not hold good as the condition antedates by months 
and even years the cardiovascular lesions. 

The causes of hyperpiesia exist long before the 
person becomes a patient and aware of his condi¬ 
tion. When symptoms such as headache, digestive 
and urinary disturbances appear, considerable dam¬ 
age will have already been done. The case has 
passed from the first stage of hyperpiesia to the 
second stage or hypertension. 

The correction of hyperpiesia in its incipiency is 
of prime importance to the individual and the first 
duty of the physician. 


Patients should be urged to have their blood 
pressures taken at stated intervals. Prophylaxis 
postpones postmortem. 


[ 16 ] 







NOTES 





NOTES 











Normal Blood Pressures 


Blood pressure depends upon six factors: 

1. Heart force. 

2. End resistance. 

3. Elasticity of the vessel walls. 

4. Amount of blood. 

5. Viscosity of blood. 

6. Vasomotor control. 

These essentials vary widely under various con¬ 
ditions all of which are set forth in modern works 
on physiology. 


To possess a general idea of what the normal 
pressures should be in any particular individual is 
not only desirable but must be closely approxi¬ 
mated to be of value in diagnosis, prognosis and 
treatment. 


While the systolic pressure, taken alone, may 
give some idea of the vascular tension it is of lit¬ 
tle value in interpretation. 

The diastolic pressure is a better guide to diag¬ 
nosis than the systolic. 


[ 17 ] 





A high systolic suggests functional disturbance; 
a high diastolic suggests pathologic changes. 

The systolic is easily influenced by the following 
conditions: 

POSITION OF THE BODY. About 4mm 
higher in standing than sitting posture. About 
4mm lower in recumbent than sitting posture. 

LOCALITY. About 4mm difference between 
the right and left side arteries. About 5mm dif¬ 
ference between the brachial and femoral artery. 

TIME OF DAY. Lower in the forenoon than 
afternoon. 

EXERCISE. Higher immediately after exer¬ 
cise, but should return to normal within ten min¬ 
utes, all depending .upon the intensity of the exer¬ 
cise. Exertion followed by fatigue lowers the 
pressure which should return to normal within one 
hour. 


DIGESTION. A fall immediately after a meal 
followed by a gradual rise, reaching the maximum 
about one hour after the meal. A cup of coffee or 
tea will raise the systolic pressure from four to fif¬ 
teen points. 


[ 18 ] 





NOTES 




• »» • 


—- 


NOTES 













SLEEP. During sleep the systolic pressure usu¬ 
ally falls to below 100mm. Normal pressure during 
sleep is about 94mm. Blood pressure elevation 
due to functional disturbances while awake is 
wiped out during sleep. Blood pressure elevation 
due to pathological changes while reduced will be 
found to be over 100mm during sleep. 


PAIN. Intense pain will always increase blood 
pressure—the greater its intensity the greater the 
elevation. Gastric crises of tabes will often raise 
the systolic pressure 70 to 80mm Hg. Hysteria 
and malingery have no effect upon arterial ten¬ 
sion. 


EXCITEMENT, ANGER, ETC. A sudden 
rise which may continue for twenty-four hours. 


FEAR. Usually followed by a fall in systolic 
pressure. 


AGE. The old dictum that the systolic pressure 
may be estimated roughly by the formula, age plus 
100 in the case of men, and in the case of women 


[ 19 ] 







age plus 100 less five per cent is, to say the leas 
decidedly inaccurate. 

The age of the patient should receive the leas 
consideration in the estimation of a normal bloo( 
pressure. It is well known that added years alse 
add many changes in the arterial tree, not througl 
age alone, but by reason of inside and outside in¬ 
fluences such as over-exertion, errors in diet, fault} 
hygiene, psychic influences, etc. There is no gooc 
reason for an individual at the age of seventy year: 
who has passed a normal life, to experience a blooc 
pressure materially higher than when twenty-five 
years of age. 


BUILD. Height and weight must be considered 
in the determination of normal blood pressures, 
An individual five feet four inches in height weigh 
ing 120 pounds will necessarily have a lower nor¬ 
mal pressure than one of the same height weighing 
160 pounds. An individual six feet in height whc 
weighs 165 pounds will not have the same pressure 
as one whose height is five feet eight inches anc 
weighs 165 pounds. 

It is impossible to announce a formula or table 
of normal pressures which could be considered ac 


[ 20 ] 






NOTES 




NOTES 







curate. However, it is quite within the limits of 
safety to consider the normal systolic pressure in 
adults to be between 110 and 140mm Hg., regard¬ 
less of age, sex, height or weight and a normal dias¬ 
tolic between 74 and 90. There may be variations 
in these figures and the individual be in good 
health. 


The Mutual Life Insurance Company of New 
York, from experience based upon 150,000 risks 
who were accepted, has placed the systolic pres¬ 
sure of healthy men of all ages and builds be¬ 
tween 114 and 142. 


The Systolic Pressure 

Is equal to the diastolic plus the pulse pressure and 
represents the force of the heart to drive the blood 
through the arteries. The diastolic pressure repre¬ 
sents the tension which the arterial walls exert 
upon the blood; it is the pressure that the left ven¬ 
tricle must overcome before the aortic valve opens. 
The systolic and pulse pressures show heart values 
and the diastolic pressure shows end resistance. 


[ 21 ] 





The relation of the three pressures should not vary 
much from 1, 2, 3. Pulse pressure 1, diastolic 2 , 
systolic 3. The typical normal pressures being sys¬ 
tolic 120; diastolic 80; pulse pressure 40 together 
with normal pulse rate. 


A sustained systolic of 115 with a diastolic of 60 
(P. P. 55) may be compatible with fairly good 
health. 

The normal pulse pressure of all adult individ¬ 
uals regardless of age, sex and build varies from 
39 to 50. 

Cadbury’s observations on blood pressure of the 
Chinese (China Medical Journal, Shanghai, Oct. 
23, 1923) shows that the systolic pressure averages 
20mm. less than the normal for people of Europe 
and North America. The diastolic pressure of the 
Chinese is also lower than the normal of individ¬ 
uals of other countries. It is a remarkable fact that 
hypertension in Chinese is very unusual. While 
chronic nephritis is very common it is seldom ac¬ 
companied with hypertension. Low blood pressure 
in Chinese is probably due to their small stature, 
light weight and low diet. 


[ 22 ] 









NOTES 









NOTES 




ETIOLOQ Y 


" 11HE causes of hyperpiesis are not definitely 
"*■ known. However, considerable testimony has 
been amassed from which we are tentatively as¬ 
sured that the principal cause lies in certain toxic 
substances circulating in the blood, and that ex¬ 
clusive of specific toxins these substances are of 
gastro-intestinal origin. 

Intestinal stasis weakens the natural defense of 
the intestinal mucosa against bacterial invasion, 
hence absorption of toxins, vasomotor disturbance 
and hyperpiesia. 

Too much fuel (food), deficient combustion and 
defective elimination are responsible factors in the 


of hyperpiesis. 



Overactive adrenals and pituitary often increase 
arterial tension. 


Allbutt says: ‘Alcohol, save of the liberal table, 
has little or nothing to do with the causation of 
hyperpiesis.” 


[ 23 ] 








Hypertension often harks back to childhood. 

Meakins and Harrington have found histanin, 
the amin from the amino-acid histidin, in intestinal 
stasis of man. It is possible that this product be 
one of the essential factors in arterial tension. 


Moschowitz says: “Essential vascular hyper¬ 
tension (hyperpiesia) is not the result of arterio¬ 
sclerosis or nephritis; arteriosclerosis itself may be 
the product of a persistent hypertension or the 
same cause which brings on the hypertension.” The 
same views are shared by Allbutt and others. 


Riesman believes that some endocrine disturb¬ 
ance is responsible for increased vascular tension, 
occurring at the time of the menopause. 


Heredity is as an important factor in most cases 
of hyperpiesia. 


Most authorities agree that long-continued infec¬ 
tions are responsible for many cases of hyperpiesia. 
Experience leads the writer to believe that acute 
infections are more often accompanied with hypo 
than hypertension. 


[ 24 ] 







NOTES 


















NOTES 









Acute infections seem to play a more important 
role in valvular diseases of the heart than myocar¬ 
dial affections. Hyperpiesis is not a frequent fac¬ 
tor in the etiology of valvular disease, yet an im¬ 
portant one in myocardial disease. 

Barach says: “In the female, chronic tonsillar 
and upper respiratory infections produce a picture 
of dysthyroidism, in the male the same infections 
are found associated with the clinical picture of 
neuro-circulatory asthenia, and this condition oc¬ 
curs in persons who are the product of a bad hered¬ 
ity plus severe or oft-repeated infection.” 

Barach also says: “Patients giving a history ol 
neurocirculatory asthenia when young and of 
hypertension in middle life constitute, in my ex¬ 
perience, the larger portion of the essential vascu¬ 
lar hypertension group. This group of cases serves 
as a connecting link between the infections of early 
life, which are followed by neurocirculatory asthe¬ 
nia and the hypertension of later life, which is pre¬ 
ceded by neurocirculatory asthenia.” 

Allbutt says: “Of the causes of hypertension we 
know nothing. It seems to be a disease of the 


[251 







well-to-do class, or whose fathers have indulged 
good appetites.” 


While we do not know what etiological factors 
are concerned in any particular case, it might be 
said that we are learning. 


There is no one etiological factor to which we 
may point and say that it is always a cause of 
hyperpiesia. What seems to be a rational expla¬ 
nation of the cause in one person may not hold 
good in another. 


The effects of tobacco on blood pressure depend 
entirely upon the effects of tobacco upon the ner¬ 
vous system. Hypotension occurs as often as 
hypertension in men addicted to overindulgence in 
tobacco. 


Damaged blood vessels due to syphilis often 
cause hypertension. 


Excess water drinking in itself may cause eleva¬ 
tion of the systolic pressure. Again, if the in- 


[ 26 ] 









NOTES 














i 




























creased water intake increases urine excretion, high 
arterial tension may be lowered. 


Ill-advised exercise “to keep fit” is a frequent 
cause of hyperpiesia and later on heart failure. 


While increased arterial tension not infrequently 
coexists with a gouty symptomology, it cannot be 
said that gout per se is a cause of this condition, yet, 
an inquiry into the patient’s family history will 
often reveal many cases of gout and rheumatism. 


While protein substances are not directly con¬ 
cerned in blood pressure elevation, it is the con¬ 
sensus of opinion of cardiologists that intestinal 
toxemia arising from intestinal stasis is a frequent 
cause, perhaps the most frequent cause of hyper- 
piesis. 


The rate of urine flow depends largely upon rate 
of blood flow and blood pressure. However, in 
kidney dysfunction hypertension should be visual¬ 
ized more as an etiological factor than a measure 
of compensation. 


[ 27 ] 








There is no doubt about the mental condition 
having a great deal to do with the stability of the 
vascular system and its effect upon blood pressure. 


The effects of altitude upon blood pressure vary 
greatly according to man’s physical condition at 
the time of the ascent. The strain upon the circu¬ 
latory system imposed by altitude is very similar 
to that induced by extreme muscular exercise. In 
an ordinary healthy individual there is little or no 
effect upon his blood pressure until an altitude ol 
8,000 feet is reached. There is practically no dif¬ 
ference in the blood pressure of healthy individu¬ 
als at sea level or an altitude of 7,000 feet. Indi¬ 
viduals with high pressures who have arterial 
changes in the form of sclerosis and those with 
poor vasomotor control do badly in altitudes above 
8,000 feet. 


Neurasthenia usually is accompanied with hypo¬ 
tension. However, many neurotics experience an 
increased arterial tension. 


The high mortality rate from chronic nephritis 
in the United States may be due to excessive pro- 


128 ] 







NOTES 


l 



* 









NOTES 












tein consumption. In countries where the pro¬ 
tein consumption is low the mortality from chronic 
nephritis is correspondingly low. 

Allbutt says: “l feel sure that hyperpiesia is 
hereditary; the moderate man of today may suffer 
by his own excesses, or for the luxurious living of 
his forefathers.” 

Biochemical findings in the blood, up to the pres¬ 
ent time, have shed no light upon the causes of in¬ 
creased arterial tension, yet, further studies may 
make possible a differential diagnosis. 


Below the age of 50 hypertension is more com¬ 
mon in men than women; after the age of 50 the 
number of cases are about equal. 


While the heart is the prime factor in starting 
the circulation its maintenance largely depends 
upon the resistance offered by the arterioles and 
capillaries. 

The prime changes in the lumen of the blood 
vessels are principally if not wholly due to the ac¬ 
tion of the vasomotor mechanism. 


[ 29 ] 









Synchronism of the endocrine glands is neces¬ 
sary to a normal circulation. 

High arterial tension may result from spastic 
contraction of the external layer of the large blood 
vessels. This phenomenon may be due to excita¬ 
tion of the sympathetic nerves with which this mus¬ 
cular layer is richly supplied. 


A purely local hypertension is sometimes en¬ 
countered in the hands, feet and portions of the 
face. To this form of capillary tension Cordier has 
applied the neonym acrocyanosis. Cordier says: 
“The primary cause seems to be some toxic action 
on the vasomotor centers.” 


A systolic of 120 in the aged should not be con¬ 
sidered hypotension. 


[ 30 ] 







NOTES 




NOTES 




THE SPHYQMOMANOMETER 

TpOR many years the sphygmomanometer was 
considered with laboratory interest only. 
Science in medicine makes haste slowly. The pa¬ 
per on the circulation of the blood by William 
Harvey was contributed in the early part of the 
seventeenth century. About one hundred years 
later Stephen Hales, a preacher, probably was the 
first to measure blood pressure by inserting a goose 
quill into an artery of a horse and noting the height 
to which the blood rose. This experiment formed 
the basis of the studies in blood pressure. About 
one hundred years later ( 1828 ) appeared the first 
mercury manometer. About fifty years later or in 
the latter part of the nineteenth century a device 
called the cardiograph was employed as a scientific 
instrument by investigators in physiology. The 
present century has witnessed great improvements 
in the sphygmomanometer. 

While there are several types of blood pressure 
registering devices only two are now in general 
use; one, a column of mercury, and the other built 


[ 31 ] 



on the principle of the aneroid, both recording the 
pressures in millimeters of mercury. 


The interpretation of signs elicited through the 
aid of mechanical diagnostic devices is liable to 
be faulty. Based upon the readings of the sphygmo¬ 
manometer many conditions are erroneously as¬ 
sumed to be present; nevertheless, it is one of the 
most useful diagnostic aids in our armamentarium. 
It is to the physician what the steam gauge is to 
the engineer and the mariner’s compass to the cap¬ 
tain of the boat. As an assistant in the diagnosis 
and prognosis of human ailments the sphygmo¬ 
manometer equals the clinical thermometer in use¬ 
fulness to the physician. 


A combination of many influences is ever active 
in the etiology of circulatory conditions and many 
mathematical contrivances have been devised for 
the elicitation of these potencies. 


While the stethoscope, the polygraph, the elec- 
trocardiagraph, the arteriometer and sphygmo¬ 
manometer are important agencies and each is val¬ 
uable in the elicitation of certain conditions, no one 


[ 32 ] 







NOTES 







NOTES 







nor all of them can be depended upon to tell the en¬ 
tire story. 

The readings of these devices properly inter¬ 
preted will visualize a picture of cardiovascular 
conditions, which, prior to their discovery j was an 
undeveloped film. The knowledge gained through 
the proper interpretation of their readings enables 
us to foresee the changes yet to come in the arterial 
tree. During the period of hyperpiesia or prevas- 
cular change, if we are prepared with modern equip¬ 
ment, pathological changes may be averted. 


Methods of Taking Blood Pressure 

Methods employed in taking blood pressure 
vary greatly. To those who still adhere to the 
readings visualized by the oscillations of mercury 
the writer desires to say that while these oscilla¬ 
tions may give some evidence of the heart’s action 
they cannot be depended upon to reveal either the 
systolic or diastolic pressure. 

The most approved method of taking blood pres¬ 
sure is as follows: 

The brachial artery of the left arm is the one of 
choice. All constricting clothing should be re- 


[ 33 ] 





moved, muscles relaxed, and arm at ease and sup¬ 
ported on a table, whether the recumbent or sit¬ 
ting posture be chosen. The cuff should be at 
least five inches in width and applied snugly to 
the arm above the elbow, making sure that it does 
not impinge upon the elbow joint; place the steth¬ 
oscope over the artery immediately below the cuff, 
inflate the sleeve until at least ten points above 
where all sound ceases is recorded, then allow 
the air to escape slowly until a distinct ‘‘click” is 
heard. This point is recorded as the systolic pres¬ 
sure. Some faint sounds usually become audible 
before the “click” is heard. Some physicians reg¬ 
ister the first sound as the systolic pressure; when 
so registered the reading is from two to eight points 
too high. 

To obtain the diastolic pressure, the valve is 
slightly opened, the air allowed to escape gradually, 
and at the point where all sound ceases is noted 
close the valve, inflate the sleeve and check the 
systolic reading again; open the valve and check 
the diastolic reading. The diastolic is sometimes 
difficult to read; if the air is allowed to escape 
from the bag too rapidly the diastolic reading will 
be too high. When the point at which all sound 


[ 34 ] 





NOTES 






NOTES 






ceases is registered it is a good plan to wait a few 
second when often the sound recurs, then slowly 
open the valve and make a new reading which will 
be the correct one. To make sure, it is well to 
check the readings the third time. All readings 
should be made in the sitting, standing and lying 
postures. 


SPHYG-METER 


2| 

ti 

CLICK 



bfl 

c 

11 

;s 

is 

^ c 

G v 
G Vh 
O 






























NOTES 








« 


NOTES 






ENERQY INDEX 

TT is important to know the total amount of en- 
ergy spent by the circulatory system in a min¬ 
ute or an hour. This information is of value in 
cases where we suspect the giving-way of the ves¬ 
sels—such as apoplexy and other hemorrhages. 

To the method of obtaining this information 
Barach has applied the neonym “Energy Index.” 
He says: “From the pulse rate we know how many 
systoles and how many diastoles to each minute 
there are in the arterial tree.” For example, if the 
systolic pressure is 120mm., the diastolic pressure 
70mm. and the pulse rate 72 per minute, the en- 
ergy exerted in one minute would be: 

In diastole 70x72 or 5,040mm. Hg. 

In systole 120x72 or 8,640mm. Hg. 

In both 190x72 or 13,650mm. Hg. 

The energy index is obtained by multiplying the 
sum of the systolic and diastolic pressures by the 
pulse rate. Repeated experiments show that the 
maximum energy index consistent with safety to 
the vascular system is 20,000mm. of mercury. The 


[ 37 ] 





normal index range is from 13,000 to 20,000. When 
less than 13,000 general cardiovascular weakness is 
suggested; when above 20,000 an excessive circula¬ 
tory load is being carried. 

A careful consideration of blood pressures, pulse 
rate and energy index will yield an abundance of 
information of inestimable value in arriving at a 
diagnosis of many pathological conditions. 




NOTES 


f 





NOTES 




PROQNOSIS 

I T is extremely unwise to proclaim a prognosis 
in any case of hypertension. The final outcome 
largely depends upon the predisposition of the 
patient. The tendency of those who suffer from 
mental strain is toward a cerebral accident; the 
overfed, to kidney complications and the. physically 
overworked to myocardial failure. 


The life of the individual with hypertension de¬ 
pends not so much upon the degree of hypertension 
as upon his inherited tendency. If he be well born 
he may carry a high vascular tension for many 
years without serious inconvenience. On the other 
hand, he often succumbs to the weaknes of his 
forebears which tends to cardiac failure, a giving 
away of the smaller blood vessels of the brain or 
to the complications of nephritis. 


After hyperpiesia has continued for some time, 
albumin may appear in the urine, but this does 
not signify more than a passing renal hyperemia. 
After cardiac dilatation develops, the renal capacity 


[ 39 ] 






becomes more and more influenced and uremic 
symptoms supervene; yet, these symptoms may be 
relieved time and again by proper treatment. 

The prognosis, in hyperpiesia, should not be 
based upon the height of the blood pressure. 
Hereditary tendency and personal history are bet¬ 
ter guides. _. 

Errors in diet, frequent attacks of tonsillitis, 
needless exposure predispose to kidney failure; 
rheumatic fever, pneumonia, diphtheria, etc., to 
cardiac failure; diseases of the nervous system, 
mental strain, etc., to cerebral accidents. 


The tendency toward certain diseases in a family 
is a valuable guide in prognosis. 


Among the causes of death in which hyperten¬ 
sion is an important factor, statistics show that 
about sixty per cent is due to cardiac failure, twen¬ 
ty-five per cent to kidney failure and fifteen per 
cent to cerebral accident. 


A persistent diastolic pressure above 90 should 
be viewed with suspicion; above 100 means path- 


[ 40 ] 











NOTES 


P 











NOTES 







ology somewhere in the arterial tree, the condi¬ 
tion having passed the hyperpietic stage into true 
hypertension. 


A sustained diastolic of 130 or over which cannot 
be reduced suggests a fatal termination within two 
to three years. 

A progressive hyperpiesia demands immediate 
attention. 

A minimum systolic of 110 and a maximum dias¬ 
tolic of 90 give a pulse pressure of 20; such an in¬ 
dividual may be in good health, yet, a weak myo¬ 
cardium and arterial changes may be anticipated 
if this ratio persist for an extended period of time. 


The mortality rate as shown by insurance com¬ 
panies increases in leaps and bounds as the systolic 
pressure exceeds 140; at 150 the increase in mor¬ 
tality over normal reaches 34 per cent and at 160 
and over to 400 per cent. It is also the experience 
of life insurance companies that overweight makes 
for increase of mortality and when combined with 
high arterial pressure makes for a very high rate of 
mortality. 


[ 41 ] 









A twenty per cent variation of the pulse pressure 
either below the minimum or above the maximum 
of normal should be regarded as at least suspicious 
of cardiovascular changes. 


A perfect heart cannot maintain a perfect circu¬ 
lation of the blood with impotent arterial walls. 

Loss of elasticity of arterial walls necessitates 
greater cardiac effort to overcome the resistance, 
and cardiac hypertrophy must follow. Hyper¬ 
trophy gradually gives way to dilatation and even¬ 
tual heart failure. 

Faught says: “The cardiovascular system is in¬ 
volved to a more or less extent in the majority of 
diseased conditions.” 


High arterial tension, though intermittent, if not 
corrected will cause disease. 


A persistent systolic pressure of 150 at any age 
will in time induce albuminuria. 


In hyperpiesia the systolic pressure is high dur¬ 
ing the day but falls to nearly normal during sleep. 


[ 42 ] 










NOTES 










NOTES 
























The heart work done by an athlete playing foot¬ 
ball for a period of three hours is not equal to one 
carrying a systolic pressure of 180 for the same 
time. 


A rapid decline in all pressures in cases of hyper¬ 
tension suggests arterial degeneration and myocar¬ 
dial failure. 


Increased arterial tension contemplates decreased 
metabolism. 


As the systolic pressure increases the efficiency 
of the heart decreases. 


Constant pulmonary stress will cause myocardial 
failure of the right side of the heart without hyper¬ 
tension being present. 

Practically all cases of chronic myocarditis are 
caused by hyperpiesia, and are associated with high 
systolic and diastolic pressures. 

Among the causes of heart disease deranged met¬ 
abolism appropriates first place. Infections take 


[ 43 ] 










first place among the causes of diseased valves of 
the heart. 


While many diabetics have arteriosclerosis ac¬ 
companied with hypertension, it is not probable 
that the blood sugar is an etiological factor in the 
hypertension. 

While a rapid decline in blood pressure usually 
precedes heart failure, the reverse is occasionally 
the case,—the high tension continuing until the 
end. 

When the systolic pressure reaches 140 in a preg¬ 
nant woman otherwise normal, eclampsia is to be 
anticipated. 


Normal systolics, high diastolics with diminished 
pulse pressures are common after apoplexy. 


When the pulse rate is higher than the systolic 
pressure expressed in mm. of mercury the circula¬ 
tory equilibrium is seriously disturbed. 


Hyperpiesia may exist for a long time before 
doing injury to a well-inherited arterial tree. 


[ 44 ] 










NOTES 




NOTES 




The symptoms and signs of arterial degenera¬ 
tive sclerosis differ materially from those of hyper- 
piesia. 


It was observed by Merchand that to men who 
worked hard with their limbs arteriosclerosis in the 
limbs was apt to arise. This local manifestation 
should not be taken as a sign of general arterio¬ 
sclerosis. 


A fluctuating difference in the systolic pressure 
of 15 to 20 mm. Hg. is of little significance. 


In aortic regurgitation the systolic pressure is 
high and the diastolic low. A fall in the systolic 
pressure in this condition forebodes danger. 


Save at its onset, the arterial tension in hyper¬ 
thyroidism is usually low, while in hypothyroidism 
the tension is usually high. 


The greater the difference between the systolic 
and diastolic pressures, the greater the heart load 
and danger of heart failure. 


[ 45 ] 










In chronic interstitial nephritis a persistent rise 
or sudden lowering of the systolic pressure is in¬ 
dicative of heart failure. 


In angina pectoris the pressure is usually high, 
when the pressure falls during a paroxysm the 
prognosis is grave. 


A sudden rise in pressure in chronic nephritis 
points to uremia. 


Low diastolic pressure in children is due to the 
elasticity of the arterial walls, therefore should not 
be considered pathologic. 


The fact that a child’s systolic pressure is easily 
influenced by emotion should always be considered; 
a turbulent temper is often responsible for a tur¬ 
bulent blood pressure reading. Repeated readings 
of blood pressure are more important in children 
than adults. 


A fall in systolic pressure after exercise sug¬ 
gests myocardial insufficiency. 


[ 46 ] 










NOTES 













NOTES 





NOTES 








NOTES 




A continued pulse pressure of over 50 or under 
30 calls for repairs. 


Blood pressures are not always high in arterio¬ 
sclerosis. 


Arteriosclerosis is often a local disease. 


Thyroid activity prevents arteriosclerosis. 


In whooping cough the systolic pressure is high; 
during a paroxysm the pressure may reach an in¬ 
tensity to cause a rupture in the walls of small ves¬ 
sels. 


Much knowledge of the condition of the heart 
may be gleaned from blood pressure readings in 
acute infectious diseases. 


[ 47 ] 












NOTES 



/ 








NOTES 






INTERPRETATION 


TNDER normal conditions the pressure ex- 
erted upon the blood vessels gives rise to no 
sensations other than those of comfort and well 
being. Materials used in the workshops of growth 
and repair as well as the waste material pass 
through the vascular system without subjective 
effects; however, there are many times when this 
happy state of affairs is upset by a multiplicity of 
causes. While for a time and often a long time 
the systolic pressure may be quite high the indi¬ 
vidual experiences no discomforture, but rather a 
feeling of exhiliration. From such individuals is 
often heard the expression “never felt better in my 
life.” 


The increased blood supply to the brain stimu¬ 
lates its activity during which period the individ¬ 
ual is often enlivened to a state of joyful exhuber- 
ation. 

The chronologic data of high blood pressure runs 
something as follows: 


[ 49 ] 







1. Defective metabolism resulting in the forma¬ 
tion of pressor substances which enter the circula¬ 
tion and stimulate the pressor nerve fibers to over¬ 
activity. 

2 . Hyperpiesia due to spasm of the arterioles. 

3. Hypertension with cardiac hypertrophy. 

/ 

4. Kidney dysfunction, intracranial tension, 
retinal changes, etc. 

5. Chronic myocarditis and nephritis. 




NOTES 


✓ 











NOTES 


\ 






PULSE RATE COMPARISONS 


rpHE picture presented by the systolic and dia- 
stolic pressures is not complete without com¬ 
parison with the pulse rate as the following ex¬ 
amples will show. A normal systolic and high 
diastolic with high pulse rate suggest myocardial 
weakness; the same systolic and diastolic with a 
LOW pulse rate suggest the opposite—cardiac 
hypertrophy. 


A low systolic, normal diastolic and normal pulse 
rate suggest neurasthenia or nervous bankruptcy, 
while the same systolic and diastolic with a HIGH 
pulse rate suggest tuberculosis or other infection. 


A HIGH systolic, HIGH diastolic and HIGH 
pulse rate suggest failing heart, while the same 
pressures with a LOW pulse rate suggest arterial 
changes and a competent heart. 


A high systolic, low diastolic with a normal 
pulse rate suggest a weak myocardium while the 


[ 51 ] 







same pressures with a HIGH pulse rate point to 
thyroid intoxication. 

Many other examples could be cited but these 
few show the importance of considering the pulse 
rate with the blood pressures in differentiating car¬ 
diovascular conditions. 


Another factor in blood pressure interpretation 
which is often underestimated is the posture of the 
patient. 

All readings, especially the first, should be taken 
in the horizontal, sitting and standing positions. 
If the readings are reversed they indicate vasomotor 
inefficiency, myocardial weakness or splanchnic 
stasis. 

If there is a rise in PULSE PRESSURE on 
changing from the horizontal to the standing pos¬ 
ture it points to cardiac hypertrophy. In the norm 
this change will cause a fall in the pulse pressure. 

The diastolic pressure normally rises in changing 
from the horizontal to the standing posture; if it 
lower look for disease of the heart. 

Should there be a fall in all pressures in chang¬ 
ing from the horizontal to the standing posture 
look for cardiac dilatation. 


[ 52 ] 





NOTES 









NOTES 





























A continued pulse pressure higher than the dias¬ 
tolic points to failing heart. A high diastolic al¬ 
ways means great vascular tension and when con¬ 
stant points to cardiovascular degeneration and 
probable cerebral accident. 

A normal systolic and pulse rate with a very 
low diastolic suggest aortic insufficiency. 

A very high systolic and diastolic with a low 
pulse rate suggest arteriosclerosis. 


A high systolic, high diastolic with low pulse 
pressure and high pulse rate suggest failing myo¬ 
cardium. 

A low systolic, normal diastolic and pulse rate 
suggest neurasthenia. 


A low systolic and normal diastolic with in¬ 
creased pulse rate suggest cardiac insufficiency. 

A low systolic and low or normal diastolic with 
increased pulse rate suggest infection. 

A low systolic and diastolic with increased pulse 
pressure suggest abnormal relation of the compon¬ 
ents of the blood as met with in anemia. 


[531 









Systolic pressure is easily influenced by physio¬ 
logical factors, while the diastolic is not so easily 
influenced. Systolic and pulse pressures show- 
heart values; diastolic shows end resistance. 


In myocardial degeneration with or without ar¬ 
rhythmia there may be high arterial tension, but 
sooner or later the pressure falls. In such cases 
if the pulse pressure be much over 50 per cent of 
the diastolic, look out for heart failure. 


In myocardial disease mild exercise will be fol¬ 
lowed by a fall in the systolic pressure. If the 
heart is competent there will be a slight rise in the 
pressure. 


In cases of nerve exhaustion the systolic pres¬ 
sure may be lower in the standing than in the sit¬ 
ting posture. 


Systolic pressure may be high in cases of weak 
heart due to the action of the vasoconstrictors in an 
effort to compensate for cardiac insufficiency. 


[ 54 ] 








In aortic incompetency there is a high systolic 
and low diastolic pressure. 


In mitral stenosis the systolic pressure is low 
due to the small amount of blood passing from the 
auricle to ventricle. 


In valvular diseases of the heart the blood pres-, 
sures are often normal. 


[ 55 ] 














NOTES 








NOTES 







TREATMENT 


TT has been said that the worst thing we can do 
is to treat the symptom, hypertension. We ap¬ 
preciate the importance of generalizing the disease 
and individualizing the patient and in no condi¬ 
tion is this more pertinent than in hypertension. 

During the stage of hyperpiesia, when no path¬ 
ology is discoverable, what are we to do; fold our 
hands and be content with the idea that an in¬ 
creased arterial tension is a compensatory measure 
and should not be combatted? The writer grants 
that in a few cases v a slight increase in the systolic 
pressure seems to serve a useful purpose. He also 
desires not only to add that a constant systolic 
pressure above 140 or a diastolic above 90, if not 
corrected, forebodes danger, but wishes to go on 
record in saying that the condition known as hyper¬ 
piesia can be corrected by the proper application 
of the high frequency current combined with com¬ 
mon sense hygienic measures. 

Until we acquire a more definite knowledge of 
the causes of hyperpiesis, its treatment must be 


[ 57 ] 





more or less empirical. However, during the first 
stage autocondensation has proven satisfactory to 
the writer. 

The management of the second stage, hyperten¬ 
sion, with well defined pathology, is an entirely 
different matter. While we still employ autocon¬ 
densation to keep the pressures within the zone of 
safety, no therapeutic measure known to possess 
value should be neglected. . 

Physiologists tell us that digitalis is a vaso¬ 
constrictor and raises blood pressure. In the writ¬ 
er’s experience with hundreds of cases of hyperten¬ 
sion no such action has been observed. Where in¬ 
dicated there can be no objection to its use in con¬ 
junction with autocondensation or any other physi¬ 
otherapeutic measure. 

Subcutaneous administration of adrenalin often 
lowers the systolic pressure in hyperpiesia and 
raises it in glomerulonephritis. 

Caffein will raise the systolic without a corre¬ 
sponding rise in the diastolic pressure, therefore, is 
contraindicated in hyperpiesia. 


[ 58 ] 








NOTES 




NOTES 





Atropin is a vaso-dilator and theoretically should 
lower the systolic pressure, but no such action has 
been observed in hypertension. 


Glonoin and other nitrites are powerful vaso¬ 
dilators and always lower the systolic pressure, but 
these effects are ephemeral and their prolonged 
use does more harm than good. 


Potassium iodid often lowers the systolic and 
sometimes the diastolic pressure, but during a pro¬ 
longed administration the potassium content irri¬ 
tates the kidneys and often causes albuminuria. 
Iodin alone is advisable when syphilis is known to 
be an etiological factor in hypertension, but as a 
routine measure iodin has but little influence upon 
blood pressure. 


Theoretically adrenalin is indicated in hypoten 
sion, but it is of little practical use in this con¬ 
dition. 


As the quantity of the blood is one of the pri¬ 
mary factors in blood pressure, venesection is some¬ 
times advisable to avert a cerebral accident, but it 


[ 59 ] 







cannot be relied upon to keep the pressure within 
the safety zone without serious effects upon nutri¬ 
tion ; the same may be said of magnesium sulphate. 
The diuretic and cholic effects of calomel are im¬ 
portant in the reduction of blood pressure, but un¬ 
fortunately can be administered only at irregular 
intervals. 

The objectionable features of the drugs just men¬ 
tioned except in emergencies preclude their use. 
This being true, to what may the physician turn 
with the expectation of relieving this most com¬ 
mon complaint? 

The high frequency current in the form of auto¬ 
condensation, diathermy and its monopolar appli¬ 
cation ; hydrotherapy for its vasomotor effects; the 
wave current for intestinal stasis, equaliza¬ 
tion of the splanchnic circulation and exercise, each 
under indications of its own will render a valuable 
service in the management of high arterial tension. 


Autocondensation Effects 

Oxygen carrying power of the blood is in¬ 
creased. 

Increases hemoglobin. 


[ 60 ] 







XOTES 




* 


* 




$ 








NOTES 








Increases oxidation. 

Increases elimination of waste products. 

Increases cellular activity. 

Increases phagocytosis. 

Raises body temperature. 

Balances vasomotor control. 

Its effects upon high arterial tension are quite 
prompt, one treatment often reduces the systolic 
pressure from 10 to 50 mm. Hg. In the course of 
twenty-four hours the pressure usually returns to 
within five or ten points of the previous day. In 
hyperpiesia the results are prompt and lasting, on 
the other hand, in cases of cardiovascular changes 
the reduction of pressure is not so marked and has 
a greater tendency to return, but even in these 
cases the reduction is progressive from day to day 
until the point of fixed tension is reached. Fixed 
tension will be found to be considerably above 
normal in every case of cardiovascular changes. 


Fixed tension is the point at which no further 
reduction can be realized. 


Faught says: “Hypertension of the vascular 
system is a condition in itself that demands spe- 


C61] 







cific treatment, irrespective of what the underlying 
clinical picture may be. The treatment for the 
basic causative factor varies, of course, with the 
nature of the complications.” 


All persons inclined to apoplexy should be under 
observation and treatment instituted whenever 
there is a rise in arterial tension. 


Autocondensation widens the blood channels and 
lightens the labor of the heart, consequently it 
lowers arterial tension. 


Patients who are overweight and have a high 
systolic pressure are benefited by a low calory diet 
with a high percentage of proteins, plus autocon¬ 
densation. 


The nervous phenomena from which women suf¬ 
fer at the period of the menopause are often re¬ 
lieved by autocondensation. 


An autocondensation dose of 300 to 600 milli- 
amperes should never be exceeded in cardiovascu¬ 
lar disease. 


[ 62 ] 









NOTES 






NOTES 






A high systolic pressure can always be reduced 
by autocondensation but it cannot always be main¬ 
tained. 


In hypertension a salt-free diet is better than a 
protein-free diet. 


A limited amount of animal protein is advisable 
in most cases of hypertension. 


The diet should be the minimum quantity com¬ 
patible with health. Only bad effects result from 
starvation. 


A diet weighed by common sense is better than 
one weighed in calories. 


Relief of constipation is of prime importance in 
the management of high arterial tension, and is 
often relieved by the wave current. 


Moderate exercise is useful; if the patient will 
not exercise, it should be done for him with the 
wave current. 


[ 63 ] 










Clinical experience teaches that treatments by 
autocondensation often repeated over a long period 
of time will soften sclerosed blood vessels. 


Patients should not be treated by autocondensa¬ 
tion within the period of two hours after a meal. 


A common fallacy is that hypertension is essen¬ 
tial to myocardial and kidney efficiency. Hyper¬ 
tension hinders the circulation through the myo¬ 
cardium and kidneys. It is easily demonstrated 
that lowering the arterial tension increases myo¬ 
cardial efficiency. Shackleford has shown that the 
urinary output as well as a diminuation of albu¬ 
min and casts are accomplished by lowering the 
blood pressure. 


Untreated patients with hyperpiesis are subject 
to the dangers of kidney and brain disease. 


Hyperpiesis from any cause is greatly benefited 
by sweat baths; hypertension is seldom benefited 
by any kind of baths. 


[ 64 ] 










NOTES 


i 








s 














NOTES 









Disturbances of metabolism are almost always 
found to be the leading factors in disease. It is 
therefore evident that permanent curative results 
cannot be obtained without a correction of the 
metabolic disorder. 


Kellogg says: “Electricity influences metabol¬ 
ism in three different ways. First, by inducing 
chemical changes in the fluids of the body and 
stimulating cell activity; second, by raising or low¬ 
ering the temperature of the tissues, thus bring¬ 
ing into action one of the most powerful of vital 
stimulants; third, by invoking muscular contrac¬ 
tion and thus irritating the series of remarkable 
metabolic activities which are associated with mus¬ 
cular movement. Muscular movements may be 
induced by galvanic, faradic or static currents, but 
the sinusoidal will be found to be most convenient 
and effective.” 


Watchful waiting of individuals with high blood 
pressure is too often the attitude assumed by the 
physician. Watching a burning building and wait¬ 
ing for the consummation of its destruction may be 
interesting, but when applied to a gradual and per- 


[651 






sistent rise in blood pressure is nothing less than 
criminal—not only vigilance but action is demanded 
in these cases. 

Diagnostic skill often prevents health preserva¬ 
tion. 

During convalescence from acute infections, rest 
in bed should be insisted upon until the blood pres¬ 
sure readings indicate the patient’s return to nor¬ 
malcy. 


A stereotyped book-made dietary to be followed 
in every case of high arterial tension is as foolish 
as it is inefficient. The peculiarities of each pa¬ 
tient should always be studied before a menu is 
prescribed. “What’s one man’s food may be an¬ 
other’s poison.” 


Hyperpiesia in children is easily controlled by 
proper hygienic measures. A blood pressure rec¬ 
ord should be made and kept of every pupil attend ¬ 
ing the public schools. 


The correction of circulatory disorders of chil¬ 
dren makes good not only for this generation but 


[ 66 ] 









NOTES 




NOTES 



v 










those to come. The fact that children of today are 
the grandfathers and grandmothers of tomorrow 
should not be overlooked. Today’s error is tomor¬ 
row’s calamity. 

Hyperpiesia will exist so long as there is an in¬ 
take of intestinal toxins. Therefore a rational con¬ 
trol of food intake and a regulation of perverted 
peristalsis are requisites in the management of high 
arterial tension. 

In hyperpiesia the success of treatment lies in 
the removal of the causative factor which is often 
difficult of accomplishment. While searching for 
the etiological factors the tension should be re¬ 
duced by autocondensation, the alimentary canal 
cleared and diet and habits corrected; if these things 
are done the chances are eight to two that no fur¬ 
ther search will be necessary. 


Allbutt says: “The best symptomatic remedy 
is the high frequency current and its effects per¬ 
sist for some time—longer as the treatment con¬ 
tinues.” _ 

While thyroid substance is known to increase 
arterial tension, its combination with ovarian ex- 


[ 67 ] 








tract will often lower the tension in women after 
the menopause. 


Costal breathing exercises and sinusoidalization 
of abdominal muscles favorably influence high ar¬ 
terial tension. 


The idea that the reduction of high arterial ten¬ 
sion is often dangerous comes from experience 
gained in the use of drugs. The tension in any 
case may be reduced by autocondensation with per¬ 
fect safety, provided proper technic is followed. 


Drugs, except in emergencies, should not be used 
to reduce arterial tension. Venesection is the best 
temporary remedy when prompt reduction of pres¬ 
sure is demanded. 


Commercial food exploitation is a menace to the 
human race. 


Any food faddist can point to special literature 
that will corroborate his theory. 


[ 68 ] 









NOTES 


0 





0 













\ 


\ 





NOTES 







\ 


Soups should be deleted from the menu of those 
who suffer from high arterial tension. 


While epsom salt is often necessary to clear the 
food tube of offending material, its daily use is to 
be deprecated. 


The time to treat high arterial tension is during 
the hyperpietic stage when it can be restored to 
normal. The longer it has continued the more dif¬ 
ficult it is to relieve. 


The effects of treatment on hypertension depend 
upon relief from its complications. 

The close relationship between hyperpiesia and 
intestinal toxemia demands a diet dictated by com¬ 
mon sense. Each case must be studied individually 
and proper diet prescribed. 

Excitation of the lower cervical reflexes will tem¬ 
porarily raise a low blood pressure. 

Excitation of the upper dorsal reflex will tem¬ 
porarily lower blood pressure. 


[ 69 ] 










Hypertension and hyperthyroidism are closely 
related to cardiovascular disease and the treatment 
of each is essentially the same. 

In over ten thousand treatments of hyperpiesia 
and hypertension by autocondensation the writer 
has not observed a single injurious effect. 

The theory that high blood pressure is essential 
to maintain the nutrition of the heart muscle is 
not supported by facts. In angina pectoris the 
pressure is usually high and the heart muscle under¬ 
nourished. Autocondensation will lower the pres¬ 
sure within the heart and increase the diastolic 
pause, thus permitting a larger amount of blood 
to reach the heart muscle. 

No fear of reducing the natural resistance to 
tuberculosis by autocondensation should be enter¬ 
tained ; whenever high arterial tension coexists with 
tuberculosis there is kidney or vascular pathology 
and autocondensation is indicated. 

The relief of hypermotility of the stomach and 
intestines will often lower blood pressure and allow 
a weak heart to recover. 


[ 70 ] 








NOTES 


\ 









NOTES 






Autocondensation lowers blood pressure thus re¬ 
lieving the labor of the heart and other symptoms 
of impaired circulation. 


After a hypertrophic condition of the smaller 
blood vessels and a mild degree of cardiac hyper¬ 
trophy has developed as evidenced by a systolic 
pressure of 170 or less, a normal or slightly ele¬ 
vated diastolic accompanied with a normal pulse 
rate, the effects of autocondensation, while not so 
prompt, are satisfactory and a favorable outcome 
may be expected. 


Even after the urinary and blood findings jus¬ 
tify a 4iagnosis of nephritis, the systolic pressure 
very high and diastolic under 120, with slightly de¬ 
creased or increased pulse rate, while the cardio¬ 
vascular condition cannot be restored to normal, 
much may be done toward prevention of further 
changes in the arterial tree. 


A normal or slightly elevated systolic, high dias¬ 
tolic and high pulse rate suggest a poor myocar¬ 
dium. This condition is best treated by autocon¬ 
densation, 330 to 450 milliamperes for a period of 


[ 71 ] 






10 to 12 minutes; the milliamperage and time may 
be varied to suit the case, but strong currents must 
be avoided. 


A normal or slightly elevated systolic, a very low 
diastolic and high pulse rate point to aortic insuf¬ 
ficiency. Autocondensation in this condition will 
probably do more harm than good. 


A very high systolic, very high diastolic with a 
normal or low pulse rate suggest arterial changes. 
While autocondensation is indicated in this condi¬ 
tion, it is advisable to begin the treatment with a 
low amperage, not over 300, for a period of 10 min¬ 
utes and gradually increase the dosage from time 
to time, but 600 milliamperes for 15 minutes must 
not be exeeded at any^ time. 

In autocondensation the current should be 
turned on ver\ r gradually consuming three minutes 
to reach the maximum; the current should also be 
turned off gradually consuming at least two min¬ 
utes in reaching zero. 


Whenever a patient coming from the autocon¬ 
densation treatment expresses himself as being 


[ 72 ] 







NOTES 




I 


( 





















NOTES 




tired, do not forget to prescribe a dose of castor 
oil to relieve him of the products of increased met¬ 
abolism. 


An enlarged heart whether it be from hyper¬ 
trophy or dilatation, is reduced by autocondensa¬ 
tion. 


Autocondensation when given for the sole pur¬ 
pose of lowering arterial tension, a dose exceed¬ 
ing 800 milliamperes for 15 minutes is not justi¬ 
fiable. 


Normal blood pressures are little, if any, affected 
by autocondensation. 

All the effects of increased metabolism may be 
secured by autocondensation without any fall in 
the blood pressures. 

In patients suffering from endocrine dysfunction 
there may be an immediate rise in all pressures on 
coming from the autocondensation couch, but this 
condition will be followed several hours later, by 
a fall. 


[ 73 ] 









Autocondensation is usually contraindicated in 
cases of hypotension; in patients whose tempera¬ 
ture is above 100 F.; in advanced arteriosclerosis; 
in cases after clearing the food tube, fainting, ver¬ 
tigo or sleeplessness occurrs. 


In cases where not over 500 milliamperes the 
chair pad is very convenient and usually satisfac¬ 
tory, but a thick dialectric mattress has the ad¬ 
vantage of better diffusion of current throughout 
the patient and lessens concentration of current at 
points of poor contact. 


No argument should be necessary to prove that 
a persistently high vascular tension is a serious af 
fair and demands efficient treatment. 


The disengorgement of the liver is often essen¬ 
tial in the treatment of high vascular tension. This 
may be accomplished with the aid of diathermy 
followed by the galvanic wave current. 


Hyperpietic hearts will soon recover their nor¬ 
mal status by the judicious use of the high fre¬ 
quency current. 


[ 74 ] 








I 




✓ 


NOTES 




























\ 

















NOTES 




Let it be understood that no claim is made that 
autocondensation always yields favorable results in 
hypertension. It has its failures as well as suc¬ 
cesses, but when employed in the proper manner it 
is one of the most potent agencies for good at our 
command in the management of cardiovascular dys¬ 
function. 



[ 75 ] 








BLOOD PRESSURE KEY 


r | THE sphygmomanometer as an assistant to the 
-*■ diagnosis of many human ailments, stands high 
among mechanical devices in usefulness to the 
physician. 

Without argument, it is now conceded by most 
cardiologists that to be of value in diagnosis, the 
systolic and diastolic pressures must be considered 
in connection with the pulse rate. 

After years of experience in blood pressure inter¬ 
pretation, the author has designed a “key” to blood- 
pressure readings for the purpose of assisting the 
busy physician in arriving at the most probable 
condition present. 

While no claim is made that the key will inter¬ 
pret all blood pressure readings, it will, in the ma¬ 
jority of instances, suggest the most probable con¬ 
dition present, making it a valuable addition to the 
equipment of every physician. 

The “KEY” will be found in the cover pocket of 
this volume. 


[761 




NOTES 


r 









NOTES 




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[ 77 ] 







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[ 78 ] 




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